Rumination and remedy: five ways to improve your outlook

by Peter KindermanPeter Kinderman is Professor of Clinical Psychology at University of Liverpool. He is an honorary Consultant Clinical Psychologist with Mersey Care NHS Trust.He is also Head of the Institute of Psychology, Health and Society at the University of Liverpool, with over 200 academic staff (32 of them professors) comprising clinical psychologists, psychiatrists, general practitioners, public health physicians, nurses, sociologists and others.The Institute conducts world-leading research in the areas of wellbeing, health services research, public health research and research into mental health and applied psychology.He also leads a MOOC (Massive Open Online Course) entitled ‘Beyond Nature and Nurture’, aimed at learners interested in learning how psychologists understand emotions, behaviours, and thinking patterns, and how this helps clinical psychologists make sense of their clients’ problems.Peter Kinderman is the author of numerous peer-reviewed research papers and his latest book is, A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing.28.09.2014

It is the events that happen in our lives that determine the state of our mental health, rather than some inherent personal inadequacy or genetic flaw. And psychological processes, such as rumination and self-blame, aren’t just symptoms of some “mental disorder” but a crucial part in the chain of causes that can lead us to depression and anxiety.

This is what we found in a recent paper. Since it was published, some people commented that this kind of psychological model can sometimes be misinterpreted to imply that people are in some way responsible for their problems because they suggest some kind of errors in thinking (although I don’t believe this). And there was naturally some response to the idea that rumination was even a problem.

The phenomenon of blaming people for the way they think about themselves, other people, the world and the future does exist. The insulting label of “personality disorder”, for example, paradoxically manages both to label people as “ill” while simultaneously blaming them for their ways of thinking.

All the things that have happened to me – my biological inheritance, parenting, education, social circumstances and cultural values and, crucially, the life events and traumas I’ve lived through, have shaped my views on life and the way I tend to think (including a tendency to ruminate). As a cognitive psychologist, I recognise that how we make sense of the world is important. But also that we learn, and can continue to learn, to make sense of it.

One of the important implications of our research is that if we were able to “turn off” rumination and self-blame, we could “turn down” at least some of the depression and anxiety. That’s really the basis of clinical psychology; there are very good reasons behind why we learn particular ways, but sometimes it might be a good idea to try and develop new ones to engage with the world.

Nearly every simple piece of advice is going to be glib, obvious, or wrong and if I were able to offer wise, self-help advice that actually worked for everybody, I’d be a millionaire. But for what it’s worth, I hope what follows will be helpful for some people.

Get the basics right

Eat good, nutritious food. Get saturated fat content down and keep salt content low. Eat enough fresh fruit or vegetables each day and drink plenty of water. Aim to get your BMI in the healthy zone. I don’t want to sound prudish, but don’t smoke, drink moderately and be generally quite cautious with recreational drugs. And get at least seven hours sleep a night. Sleep is really important and studies suggest the brain needs sleep to also remain physically healthy.

There’s lots of advice and specific help out there. But the message is the same: get the basic physical fundamentals right.

Well-being: five tips for the price of one

The “five ways to well-being” approach is recommended by the mental health charity MIND and the NHS, and there are plenty of doable steps.

Keep active – do something physical each day. It could be as simple as taking the dog out for a walk (if you’ve got one).

Maintain your relationships – for all kinds of reasons, friends are vital. Good friends, supportive friends, friends who won’t judge you or try to take advantage of you. We can all take steps to maintain these friendships; phone, write, text. You might even consider a kind of semi-professional approach; self-help groups to meet people in a similar position.

Give – this isn’t political brainwashing. There’s good evidence that getting involved in charitable activity (and it’s probably better to give your time and effort, rather than money) makes people happier.

Stay open-minded – perhaps the trickiest thing to do but it relates directly to rumination.

Mindfulness

Rumination – compulsively focusing your attention on the causes and consequences of a problem – tends to be eased by learning to be mindful: if we’re able to be aware of, and understand how our own thoughts work. This does not mean taking up any kind of religious practice, but some practical techniques for clearing the mind of “clutter” can be helpful.

In part, it means becoming able to decide where to focus your attention. Because if you’re good at this, it’s less likely that your thoughts will always drag back towards rumination.

The CBT approach

If you’re aware of what’s happening in your own mind, you can start to change things. My colleague, Sara Tai, put together a neat summary of cognitive behavioural therapy, or CBT. But it works like this:

Identify what you are thinking. It’s often really useful to do this when you notice a change in your emotions or if you start doing something that may be a sign of something else, like drinking too much. So if you think someone you know ignores you in the street and you feel sad this can be a cue to examine the thought.

Are you (after engaging your fantastic brain in a mindful manner) thinking sensibly, wisely and proportionately about the situation? Weigh up the evidence – what makes you think they ignored you? Could it be they didn’t see you? Did you “assume” they ignored you and is your mood also now affecting the way you’re thinking?

Change it. Generate an alternative point of view; question the evidence for your negative thoughts and find possible alternatives. It’s not about lying to yourself – maybe they did ignore you. But when in a negative frame of mind, we can assume the worst.

Therapy

If you’ve tried all that then you could try therapy. I wouldn’t recommend it for everyone – many people are probably better off avoiding therapists and using everyday resources and support. But it can be a chance to think things through with a professional in a calm, supportive and nonjudgmental atmosphere, which can be helpful. I personally prefer the straightforward approach of CBT, but there are many others. It’s a question of finding one that suits you.

If all of this was easy, I wouldn’t have a job and you’d have found the secret years ago. But while you aren’t guaranteed lifelong contentment, sort out some of these basics and it might help.

Peter Kinderman does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

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